Why agree to a hysterectomy?

Why would a woman agree to surgical removal of the uterus when a hysterectomy-saving procedure, "endometrial ablation," is available? Given this choice, the answer is obvious. But today thousands of women have never heard of this less invasive procedure due to political bureaucracy, short-sighted financing and a lack of trained doctors. So what should female patients and their families do to correct this situation? After all, good sense indicates it's madness to cut off an arm when amputating a finger will do.

Today, one woman in five over the age of 35 will have a hysterectomy. This requires several days of hospitalization, is more risky than endometrial ablation and requires several weeks of convalescence. But following endometrial ablation patients are back to normal in a couple of days.

A hysterectomy is done for a variety of medical reasons. In some cases the endometrial lining of the uterus becomes too thick (hyperplasia), resulting in heavy and prolonged periods. Other women develop benign fibroid growths in the wall of the uterus causing bleeding and pain. In some, hormonal reasons explain the bleeding, or a malignancy of the uterus.

The principle of endometrial ablation is sound. Rather than cutting out the uterus, gynecologists eliminate the problem. In most cases this involves destroying the lining of the endometrial uterus by either laser, microwave therapy, electrocoagulation or extremely hot water.

Endometrial ablation has other significant advantages. If fibroids are present it's often possible to remove them at the same time. It can be performed as an outpatient procedure in 20 to 30 minutes.

Dr. Nick Leyland, Chief of Obstetrics and Gynecology at St. Joseph's Health Centre in Toronto, along with other gynecologists, has recommended the establishment of free-standing clinics that would offer this procedure for women. So why isn't it done? Here's a good opportunity to see both the good and bad sides of medical care in Canada, and the U.S., and in the final analysis it's all about the money.

In the U.S endometrial ablation is readily available due to fierce competition among hospitals.

If you have the money, there's no problem in obtaining the procedure. The bad news is that millions of Americans do not have medical insurance and this is the great criticism of medical care in that country.

IRONIC SITUATION

Then there's the ironic situation in Canada. Here you could be a multi-millionaire and say to hospital administrators, "Here's a donation of a million dollars.

Now you have funds to pay for the disposable equipment required for endometrial ablation and now let's get on with the procedure." And they would reply, "We'll take your money but you still have to wait in line, because we have to provide universal health care."

In Canada the government does the usual bureaucratic thing. The disposable equipment for endometrial ablation costs between $600 and $1,000. Rather than provide hospitals with these funds politicians continue to spend thousands of dollars on hysterectomies that require several days of expensive hospitalization. You don't need an MBA from The Harvard Business School to conclude this is financial madness. The only exception is Alberta where hospitals offer the procedure using local anesthetic.

Dr. Leyland claims that endometrial ablation is successful in controlling bleeding in 95 percent of cases and that only a few patients need a subsequent hysterectomy. The complication rate is only one percent.

But this procedure isn't for every woman with abnormal bleeding. For instance, it cannot be used if malignancy is the cause of the bleeding. Or if a woman of reproductive age still wishes to have children. And this procedure cannot resolve problems associated with extensive pelvic infection.

Dr. Leyland says that in Canada only 10% of gynecologists currently have the skills to do endometrial ablation. These specialists are primarily in the university centres and it will take several years to train other doctors in this technique.

In the meantime women who are told they need a hysterectomy should always ask if their problem could be treated by endometrial ablation. And if so, is there a gynecologist who could perform it?

Endometrial ablation will reduce the number of hysterectomies currently being done. It will also provide a psychological boost for women who dislike the thought of losing their uterus. And an added benefit, save health care resources.